eHealth in SEAR (South East Asia Region of WHO)

Health Situation & Trend Assessment (HST) Dept. of Health System Development

SEARO/WHO

The importance of e-health & urgency to act is growing   Recommendation of the Commission on Information and Accountability

–  Integrated use of Information and Communication Technologies (ICT) in national HIS and health infrastructure, by 2015

  Globally e-health / m-Health increasingly used in all aspects of health –  Health promotion, health education, health information, assessments,

monitoring, surveillance, etc. –  Individual patient management and service delivery

  E-health offers powerful opportunity to bridge the health gap with –  Increasing mobile phone accessibility –  Widespread access to Internet –  Social media reaching out more people –  Multi-lingual environments availability

  Coordinated efforts required –  Multi-sectoral approach - Govt. and partners need to work together

Last decade: 4 Pilots in SEAR have shown its usefulness   Goal: to improve health service

delivery in particular and health system performance in general, through the use of ICT

  3 step implementation approach for Pilot projects

–  Step 1: Improve access to Information (tele-education)

–  Step 2: Improve access to Advice (tele-consultation)

–  Step 3: Improve access to diagnosis & patient management

Bhutan: Telemedicine for Service Delivery is an important option   Bhutan has been making sincere efforts to implement

Telemedicine since 1997 –  3-step approach was piloted in 6 sites (2000-2005) –  By 2004, the utilization improved to 20 consultations / month

  Lessons learnt from pilots, led to development of a National plan for Telemedicine in 2006

–  Not implemented due to funding constraints

  2007: Expansion done to 10 more sites (JAICA Project)

  2008: SAARC project established at National hospital –  Provides Telemedicine consultation and CME services –  From two super-specialty hospitals in India

  2009: Rural Telemedicine Project (RTP) initiated at 14 sites

Bhutan: Decade experience led to National strategy 2011  Telemedicine project Review done in 2011 suggested:

–  Insignificant investment has gone into the “People” aspect of making the change happen

–  Interviews with 10 RTP sites: we moved from Pilot project to National Program without essentials in-place

–  Interviewes with 7 Specialists at National Hospital revealed: An incentive system can motivate response off-hours

 National strategy provides phased approach for 3 years –  1st year: Integrate telemedicine with Health Call Centre –  2nd year: Further strengthen “People” aspects and SOPs –  3rd year: Impact assessment to develop medium-term

strategy and operational plan

DPRK: Telemed expanded to 60 sites after successful pilot   In 2007, WHO undertook a country’s need analysis and infrastructure

readiness survey followed by planning a pilot project in 2008.

  In 2009, the pilot system was launched in 3 sites representing central, provincial and county levels to assess the adaptability and functionality of the system.

  Overall utilization was good at the all 3 pilot sites.

  During 2011, WHO/SEARO proided funding & technical support for establishing 60+ new sites.

  Now, all provincial hospitals and 60 county hospitals are connected through the telemedicine system –  Tele-consultation for diagnosis and treatment of difficult cases –  Tele-education for in-service medical staff

  In-country Project assessment is planed in August 2012

  Development of a National Policy on Telemedicine and study tours for capacity building are being planned for the near future.

Sri Lanka is implementing various e-health initiatives   Telemedicine pilot project established in 2002-03 was used

during Tsunami at one site, however 3 out of 4 sites were wiped off by Tsunami

 Sri Lanka’s responsible agency (ICTA) is taking forward various e-health initiatives

–  installed an open source Hospital Information Management System in various hospitals

 A number of other isolated systems developed by Family Health Bureau, Epidemiology Unit, Medical Statistics Unit etc

 WHO plans to work with ICTA on eHealth projects to ensure compliance to standards and norms

Maldives piloted telemedicine in 4 sites, evolved into data system

  The review of the Telemedicine Pilot indicated more need on data sharing and e-learning

  Therefore, SEARO implemented SIDAS at Atoll level, –  Integrated tool for, data collection,

analysis and presentation (GIS) developed by WHO/SEARO

  Late 2010, WHO/SEARO provided inputs to draft the National eHealth strategy for Maldives

Global Observatory for eHealth provides useful indicators & data  Objective of the GOe was to undertake a global survey on

eHealth to determine a series of benchmarks at national, regional, and global levels in the adoption of the necessary foundation actions to support the growth of eHealth

–  GOe conducted a survey in 2005 & 2009

 WHO’s eHealth resolution adopted in 2005 focuses on strengthening health systems through the use of eHealth

–  The Observatory model combines WHO coordination regionally and at headquarters to monitor the development of eHealth worldwide

  8 SEAR countries participated in the 2009 GOe survey –  BAN, BHU, IND, INO, MAV, NEP, SRL, THA

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o  Telemedicine policy in 1(12.5%),

o While only 1 country partially implemented National Telemedicine policy

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Regional Strategy implem. would strengthen HIS in SEAR   10 Point Regional strategy to strengthen HIS in SEAR countries has

been Endorsed by RC59 in 2006 and RC63 in –  Significant improvement to be reported to the RC by 2015

  HMN assessments done in 6 countries in 2007-08 and their HIS plans updated.

  Implementation of COIA recommendations also compliments the implementation the regional strategy.

  There is an urgent need to have a fully functional Regional Health Observatory to collate information required by decision makers.

  Every country in SEAR has an HIS, with different levels of maturity. Some improvements done since 2007 in line with the regional strategy.

–  More work required on: disaggregation of data, data quality, data management at sub-national level and district level, data collation from multiple sources, standards, interoperability, ICD-10, CRVRS, ………

Improving Civil registration and Vital statistics system   Recommendation of the COIA: Significant improvement in the reporting

of vital events in all countries by 2015 –  6 of the 11 countries of the SEAR region have made a commitment

  Tool to assess country CRVS System developed by WHO & UQ, was pilot tested in Sri Lanka in 2009

  In Maldives, assessment of the coverage and completeness of the VRS was undertaken in 2010-11, the causes of deaths validated and training on verbal autopsy conducted.

  Currently comprehensive assessment is going on in 2 SEAR countries – Timor-Leste & Indonesia, Planned in 2 countries – Bangladesh & Myanmar.

  DPRK & Thailand are undertaking rapid assessment

  SEARO is following up with Bhutan, Nepal and India for conducting assessment at the earliest.

Countries have e-Health projects worth sharing with others  Bangladesh MOVE-IT:

–  to register all pregnant mothers and their children in Bangladesh in a unified electronic information system by leveraging a multi-stakeholder collaborative framework.

  Indonesia MOVE-IT: –  to develop and implement software solutions for data entry,

management, quality control and processing of vital registration data from a selected sample of field sites in Indonesia.

  Indonesia: Verbal Autopsy using mobile phones at community level

  India innovation initiative: –  eMamta of Gujarat, adopted by nationally – to track MCH services

The importance of e-health & urgency to act is growing   Recommendation of the Commission on Information and Accountability

–  Integrated use of Information and Communication Technologies (ICT) in national HIS and health infrastructure, by 2015

  Globally e-health / m-Health increasingly used in all aspects of health –  Health promotion, health education, health information, assessments,

monitoring, surveillance, etc. –  Individual patient management and service delivery

  E-health offers powerful opportunity to bridge the health gap with –  Increasing mobile phone accessibility –  Widespread access to Internet –  Social media reaching out more people –  Multi-lingual environments availability

  Coordinated efforts required –  Multi-sectoral approach - Govt. and partners need to work together

The way forward  WHO to support development of National eHealth / mHealth

policies, National telemedicine policies

  Implement Regional strategy for improving HIS

 Establish pilots in other requesting countries

 Evaluation of pilot projects

 Organize regional meeting to share experiences and plan a roadmap to accelerate the e-health / m-health initiatives in the country

 Harness initiatives and developments under COIA recommendations and MOVE-IT

Brain Gym

Quiz

Mobile Cellular Subscriptions per 100 population  Highest subscribing countries

–  Estonia : 202.99 –  Qatar : 175.4 –  Saudi Arabia : 174.43

  Lowest subscribing countries –  Eritrea : 2.78 –  Ethiopia : 4.89 –  Brundi : 10.10

 A few surprises –  Madives : 147.94 –  USA : 94.83 –  Kyrgyzstan: 81.85

Brain Gym

Quiz

Mobile Cellular Subscriptions per 100 population

Country Subscriptions Country Subscriptions

Bangladesh 31.07 Mongolia 84.36

Bhutan 46.9 Myanmar

Cambodia 37.78 Nepal 25.97

China 55.51 Pakistan 56.96

India 43.83 Philippines 80.98

Indonesia 69.25 Singapore 140.43

Korea, Republic 99.2 Sri Lanka 69.65

LAO PDR 51.18 Thailand 122.57

Malaysia 110.6 Vietnam 100.56